<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Surname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-surname" data-rule="required" class="form-control" name="row[surname]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone_see')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone_see" class="form-control" name="row[phone_see]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Estimate_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-estimate_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[estimate_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="0"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Report_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-report_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[report_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-type" data-rule="required" class="form-control" name="row[type]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Type_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-type_id" data-rule="required" data-source="type/index" class="form-control selectpage" name="row[type_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Need')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-need" class="form-control " rows="5" name="row[need]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Staff_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-staff_id" data-rule="required" data-source="staff/index" class="form-control selectpage" name="row[staff_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Code')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-code" class="form-control" name="row[code]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Strike_data')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="strikeDataList" item="vo"}
            <label for="row[strike_data]-{$key}"><input id="row[strike_data]-{$key}" name="row[strike_data]" type="radio" value="{$key}" {in name="key" value="0"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Strike_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-strike_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[strike_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lapse_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lapse_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[lapse_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Connection_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-connection_id" data-rule="required" data-source="connection/index" class="form-control selectpage" name="row[connection_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Collision_data')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="collisionDataList" item="vo"}
            <label for="row[collision_data]-{$key}"><input id="row[collision_data]-{$key}" name="row[collision_data]" type="radio" value="{$key}" {in name="key" value="0"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Collision_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-collision_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[collision_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
